ISPOR Avedis Donabedian Outcomes Research Lifetime Achievement Awardee: Kathleen N. Lohr, PhD

Bryan Luce PhD, MBA
First, I want to recognize my fellow committee members: Penny Erickson, Kevin Schulman and Adrian Towse. Dan Mullins was an unofficial committee member and was also helpful in the selection process. We had a difficult time this year in that we had an extraordinary slate of qualified candidates.

It gives me extreme pleasure to announce that the ISPOR Avedis Donabedian Outcomes Research Lifetime Achievement Awardee this year is Dr. Kathleen N. Lohr. Kathy, as she is known to all her many friends and colleagues, exemplifies the work, the aspirations and the achievements of Dr. Donabedian.

Dr. Lohr received her bachelor’s and master’s degrees from Stanford University in sociology and education, respectively, and her PhD in Public Policy Analysis from the RAND Graduate Institute.

For the past 30 years, Kathy has been engaged in, contributed to, and often led nationally and internationally prominent health services research and health policy analysis related to improving the health outcomes of the public.

Dr. Lohr is best noted for her accomplishments in the areas of quality of care, clinical practice guidelines, health status assessment, and related health policy areas. In fact, Kathy has displayed an uncanny knack for gravitating to, and leading, efforts in seminal health policy issues of her time. She began her health services research career at The RAND Corporation, where she worked with such luminaries as Robert Brook and John Ware. You might note that Dr. Ware was the first recipient of ISPOR’s Donabedian Award.

At RAND, over a 13-year period, Kathy worked chiefly on the landmark RAND Health Insurance Experiment and on other health services research and policy areas mainly involving quality of care, outcomes and health status assessment, and health insurance as well as methods development. During this time, Kathy contributed to the development of the “episodes of care” methodology; evaluated the impact of EMCROs, which were the precursors to Medicare’s Peer Review Organizations or PROs; and pioneered the use of Medicaid claims files for use in quality assurance.

In 1987, Kathy joined the Institute of Medicine of the National Academy of Sciences, where she worked for 9 years. There she directed the study titled “Medicare: A Strategy for Quality Assurance,” which evaluated the Medicare PRO program. This study produced the best-known and still-used definition of quality of care in this country today. That definition is: “Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” The study prompted Medicare to adopt a quality improvement orientation that has led to the work of the Quality Improvement Organizations, the successor to the PROs. She also directed a series of key studies for Medicare to set a research agenda for the well-known “Effectiveness Initiative,” which became the basis for many legislative efforts to follow including Patient Outcomes Research Teams, or PORTs, at the then Agency for Health Care Policy and Research (AHCPR), that populated health services research centers around the U.S. during much of the 1990s.

During her tenure at the IOM, Dr. Lohr also codirected the studies on clinical practice guidelines for the Agency for Health Care Policy and Research, now the Agency for Healthcare Research and Quality. One report provides the first, best-known, and internationally used definition of clinical practice guidelines: “systematically- developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.” In 1996, Kathy left Washington D.C. with her husband Bill to join the Research Triangle Institute - now RTI International -- where she became a Chief Scientist and is now a Distinguished Fellow. Two years later she joined the University of North Carolina at Chapel Hill where she is now a Research Professor in the School of Public Health.

Kathy founded and still directs the RTI-UNC Evidence-based Practice Center funded by AHRQ. Under her leadership, the EPC has completed more than 50 systematic reviews and updates, including many for the US Preventive Services Task Force.

In the unlikely event that I haven’t yet convinced you of Kathy’s extraordinary contribution to the outcomes field over the past 30 years, let me also note that Dr. Lohr has produced more than 50 books, monographs or government reports, 18 book chapters, more than 100 peerreviewed journal articles, almost 30 RAND reports, and more. She is Associate Editor of Quality of Life Research; she is or has been a member on numerous nationally prominent committees or boards including ones for the Joint Commission on Accreditation of Healthcare Organizations, the US Pharmacopeia, and the Institute of Medicine and the National Academies.

Finally, on a more personal note, both Kathy and her husband Bill, who himself worked for years at the predecessor of AHRQ, have been close family friends of me and my wife. She is an absolutely lovely, unassuming woman. When I called her to tell her she was nominated…NOMINATED… this was before she was chosen for this award…Kathy was beside herself with disbelief and appreciation.

Ladies and gentlemen, please join me in welcoming Dr. Kathleen N. Lohr to the platform to receive the ISPOR Avedis Donabedian Outcomes Research Lifetime Achievement Award.

Kathleen N. Lohr, PhD
Well, I am speechless - nearly - with delight and appreciation, and I will try to be short. I do want to thank Bryan, who, as he said, is a long-time family friend, and the selection committee, and ISPOR more generally, for honoring me with the Avedis Donebedian award. Really, nothing could give me more pleasure. I would first like to acknowledge the source and the motivation of this award. ISPOR has been now, for a decade, in the forefront of health outcomes assessment, in the field of pharmacoeconomics and by extension to public policy in the health sector more generally. The broad set of scientists who constitute this society’s international membership work very hard, indeed, to translate outcomes research into clinical practice and public health, in ways that benefit patients, their families, providers of all types, and indeed all societies. So it is quite fitting, I think, that ISPOR would elect to name a lifetime achievement award in honor of one of this country’s - but really the world’s - paramount physicians, philosophers, and scholars.

Avedis Donebedian, for those of you who were not fortunate enough to know him, was a tall, spare, courtly gentleman. He had had a remarkable personal and family history that took him from pre-World War II Lebanon, through medical training in pediatrics and then later in public health, to become the Nathan Sinai professor of public health at the University of Michigan in Ann Arbor. But more relevant perhaps for today’s event, Professor Donebedian was the seminal leader; one might rightly say the founder, of the modern field of quality of care. He had first articulated his breakthrough concepts that quality of care can be parsed in terms of structure, process, and outcomes in a seminal article published in 1966 in the Milbank Memorial Fund Quarterly.

I note how many students are here today, so a word of sort of instruction if you will: Professor Donebedian wrote many, many articles, books, chapters - you name it - but he once told me that the citation that he most liked for his work setting out the by-now classic triad of structure, process, and outcome was in fact that 1966 Milbank article. So if you ever have occasion to be writing about quality of care and you want to know really what to cite, that is it.

I think it is quite fair to say that the triad of structure, process, and outcome is the backbone on which virtually all of the work in quality measurement and assurance and improvement rests today. By definition, then, the outcomes element of the ISPOR award turns on the elegant constructs that he had developed through tightly argued books and articles and lectures. So an award that acknowledges those individuals who have made major breakthroughs and contributions to improving health outcomes is indeed rightly named after him.

Finally, I should like to mention briefly those who helped me along the way to be standing here today and acknowledging the advances that have been made over the years in quality of care and outcomes research. Bryan scooped me a little, but it really starts in the 1970s at The RAND Corporation, under the expert guidance and unshakable support in quality of care research that I got from Bob Brook, who had been an early protégé of Professor Donebedian. At the same time, I was fortunate enough to have a groundbreaking introduction into health status assessment from John Ware, who indeed was ISPOR’s first Donebedian awardee a couple of years ago. It then continues with my work at the Institute of Medicine, where I had unfailing and unstinting support from both Sam Thier and Ken Shine, the successive presidents of the IOM while I was there, and who I think really tried to put quality of care issues back on the national agenda through a considerable support for a whole array of quality of care work that, of course, continues to the very present. I also would like to acknowledge Agency for Healthcare Research and Quality (ARHQ) in general. We have had a wonderful eight years with our evidence-based practice center, and I am a huge fan of all of the work that AHRQ has been able to support in that arena and hopefully will continue to do so, including expanding our efforts in comparative effectiveness research coming down the road in the next couple of years. Finally, although clearly not least, I would like to salute my husband Bill Lohr, who is here today and as Bryan said, was himself a great supporter of health services research and health status assessment in the years that he was at the National Center for Health Services Research, a precursor, a couple of agency names back, of AHRQ. And I would like to acknowledge, as well, my sons and daughter, all of whom have made it possible for me to stand here today and thank you, most profoundly, for this marvelous honor.

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